Healthcare Provider Details

I. General information

NPI: 1538816434
Provider Name (Legal Business Name): DR. ISSAR DARYANANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE BLDG 1750
JBPHH HI
96860-4908
US

IV. Provider business mailing address

91-2301 OLD FT WEAVER RD
EWA BEACH HI
96706-3602
US

V. Phone/Fax

Practice location:
  • Phone: 888-683-2778
  • Fax:
Mailing address:
  • Phone: 808-671-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-1999
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: